Successful combinations of drug and non-drug therapy for low back pain

Golovacheva V.A.; Golovacheva A.A.

doi:https://doi.org/10.17116/pain20242201157

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Abstract:

Low back pain (LBP) is one of the most common complaints with which patients are consulted by neurologists and therapists every day. Therefore, knowledge and ability to correctly diagnose and treat patients with LBP are integral professional skills of a neurologist and therapist. Clinical cases of management of patients with LBP are described. A modern and effective approach to the diagnosis and treatment of LBP associated with musculoskeletal disorders and discogenic radiculopathy is presented. Shown are the typical, most common red and yellow flags found among patients with LBP. Typical comorbid disorders in LBP and the importance of their timely diagnosis and treatment are demonstrated. To treat patients with chronic musculoskeletal LBP, a comprehensive approach was used, including educational conversations about the disease, kinesiotherapy, and a course of pharmacotherapy with a nonsteroidal anti-inflammatory drug (NSAID) and a muscle relaxant for 14 days. The drugs of choice were aceclofenac and long-acting tolperisone. A comprehensive, multi-stage approach was used to treat a patient with acute lumbar ischialgia and discogenic radiculopathy. From the first days of treatment, an educational conversation was held about the disease, recommendations were given on physical activity, and aceclofenac and long-acting tolperisone were prescribed for 14 days. From the second week of treatment, due to persistence of intense pain associated with radiculopathy, gabapentin was prescribed. After 14 days, after the pain subsided, kinesiotherapy was added to the treatment. In all of the described patients, by the 3rd month of treatment, pain regressed and daily activity returned to normal. By the 6th month of observation, the achieved results were maintained.

Keywords:

low back pain

lumbar ischialgia

musculoskeletal pain

discogenic radiculopathy

diagnosis

treatment

kinesiotherapy

therapeutic exercises

pharmacotherapy

aceclofenac

tolperisone

gabapentin

Authors:

Golovacheva V.A.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-2752-4109

Golovacheva A.A.

Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0002-2845-7323

Received:

25.01.2024

Accepted:

30.01.2024

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